Bilateral pneumothoraces complicating reduction mammoplasty: a case report

BACKGROUND: Bilateral pneumothoraces after cosmetic breast surgery are rare and sporadically reported in the literature. CASE PRESENTATION: A 65-year-old female patient developed bilateral pneumothoraces after bilateral breast reduction surgery. Emergent chest tube thoracostomy was performed on both sides. The chest drains were removed on the fourth day (left side) and sixth day (right side), and the patient was discharged after 7 days of hospitalization without any further complications. CONCLUSION: To our knowledge, the English-language literature contains no other reports of bilateral pneumothoraces after reduction mammoplasty

Vaspin: a novel adipokine, member of the family of serine protease inhibitors

In 2000, the novel adipokine vaspin, which belongs to the superfamily of serpins, was isolated from visceral adipose tissue. Vaspin is mainly produced in the visceral adipose tissue and is related to insulin resistance, blood glucose levels, sex hormones (women have higher levels compared to men) and nutritional status. Moreover, vaspin levels are modulated by weight loss and several agents, and it possibly constitutes a connecting link between obesity and its associated metabolic disorders. Many patients with polycystic ovary syndrome have insulin resistance, obesity (mostly visceral) and glucose intolerance, conditions associated with abnormalities in the production of vaspin. The role of vaspin in the regulation of human metabolism is unclear at present, but it appears that vaspin might represent a novel marker of obesity and insulin resistance. However, the controversial findings of existing studies on vaspin stress the need for further research in women with obesity and metabolic disorders in order to elucidate the role of this adipokine in these diseases and particularly in the polycystic ovary syndrome

Post-COVID-19 Parkinsonism and Parkinson's Disease Pathogenesis: The Exosomal Cargo Hypothesis

Parkinson's disease (PD) is the second most prevalent neurodegenerative disease after Alzheimer's disease, globally. Dopaminergic neuron degeneration in substantia nigra pars compacta and aggregation of misfolded alpha-synuclein are the PD hallmarks, accompanied by motor and non-motor symptoms. Several viruses have been linked to the appearance of a post-infection parkinsonian phenotype. Coronavirus disease 2019 (COVID-19), caused by emerging severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, has evolved from a novel pneumonia to a multifaceted syndrome with multiple clinical manifestations, among which neurological sequalae appear insidious and potentially long-lasting. Exosomes are extracellular nanovesicles bearing a complex cargo of active biomolecules and playing crucial roles in intercellular communication under pathophysiological conditions. Exosomes constitute a reliable route for misfolded protein transmission, contributing to PD pathogenesis and diagnosis. Herein, we summarize recent evidence suggesting that SARS-CoV-2 infection shares numerous clinical manifestations and inflammatory and molecular pathways with PD. We carry on hypothesizing that these similarities may be reflected in exosomal cargo modulated by the virus in correlation with disease severity. Travelling from the periphery to the brain, SARS-CoV-2-related exosomal cargo contains SARS-CoV-2 RNA, viral proteins, inflammatory mediators, and modified host proteins that could operate as promoters of neurodegenerative and neuroinflammatory cascades, potentially leading to a future parkinsonism and PD development

The criteria of fiscal discipline on the construction of the Eurozone: the case of Greece

The criteria of fiscal discipline on the European edifice are the indicators upon which it was agreed and decided the control of whether the European Union member states fulfill their obligation about fiscal discipline. Many issues arise on the implementation of these criteria. The case of Greece demonstrates these issues with a lively way and reveals the challenges facing both the country and the EU on the way towards european integration. The aim of this thesis is the deeper understanding of these challenges as well as the formulation of thoughts that could help addressing them. This thesis analyses the provisions of EU law (primary and secondary) that impose fiscal discipline on the member states and determines the criteria of fiscal discipline. It reveals the intense political characteristics of the procedure of excessive deficit and the decisions taken under it, which have been manifested clearly in the case of Greece. It examines the economy and in particular the creation and evolution of Greek budget deficits during the period 1981-1994 and the final period 1994-2000, which led the country to enter the third stage of EMU. Then, the analysis of the period after joining the third stage of EMU and the EU intervention on the country's fiscal management follows, with key points the country's status “under surveillance” in the summer of 2004 and the spring of 2009 and as pinaccle the “Memorandum” after the breakout of the debt crisis. It should be noted that the adventure of Greece and mainly the need to protect the Euro has had as a consequence the anticipation and specification of the possibility of granting EU financial aid to a member state facing difficulties. Also, the two institutions that were born because of the Greek crisis are analysed, namely Regulation (EU) 407/2010 establishing the European financial stabilasation mechanism and the European Financial Stability Fund. Finally, it is highlighted the need for better coordination of the multilateral surveillance and the deepening of the preventive institutional framework of the Union with respect of the specificities of each member state economy as well as the need for the creation of European institutions capable of encountering the markets. Similarly, at national level, it is noted the degradation of the state and its economy and the need for restructuring taking into account the respect for human rights and welfare state.Τα κριτήρια δημοσιονομικής πειθαρχίας στο ευρωπαϊκό οικοδόμημα, αποτελούν τους δείκτες με βάση τους οποίους συμφωνήθηκε και αποφασίστηκε να ελέγχεται εάν τα κράτη μέλη της Ευρωπαϊκής Ένωσης εκπληρώνουν την υποχρέωσή τους να επιδεικνύουν δημοσιονομική πειθαρχία. Πολλά είναι τα ζητήματα που ανακύπτουν κατά την εφαρμογή των εν λόγω κριτηρίων στην πράξη. Η περίπτωση της Ελλάδας αναδεικνύει με γλαφυρό τρόπο τα ζητήματα αυτά και αποκαλύπτει τις προκλήσεις που αντιμετωπίζει τόσο η χώρα όσο και η Ένωση στην πορεία προς την ευρωπαϊκή ολοκλήρωση. Σκοπός της διατριβής είναι η βαθύτερη κατανόηση των προκλήσεων που ανακύπτουν, καθώς και η διατύπωση σκέψεων που θα μπορούσαν να βοηθήσουν στην αντιμετώπισή τους. Η διατριβή αναλύει τις διατάξεις του δικαίου της Ένωσης (πρωτογενούς και παράγωγου) που επιβάλλουν την τήρηση της δημοσιονομικής πειθαρχίας από τα κράτη μέλη και καθορίζουν τα κριτήρια δημοσιονομικής πειθαρχίας. Αποκαλύπτει τα έντονα πολιτικά χαρακτηριστικά της διαδικασίας υπερβολικού ελλείμματος, αλλά και των αποφάσεων που λαμβάνονται στο πλαίσιο αυτής, τα οποία έχουν εκδηλωθεί καθαρά στην περίπτωση της Ελλάδας. Εξετάζει την οικονομία και ειδικότερα τη δημιουργία και εξέλιξη των δημοσιονομικών ελλειμμάτων της Ελλάδας κατά την περίοδο 1981-1994, και την περίοδο 1994-2000, που οδήγησε τη χώρα στην ένταξη στο τρίτο στάδιο της ΟΝΕ. Ακολουθεί η ανάλυση της περιόδου μετά την ένταξη στο τρίτο στάδιο της ΟΝΕ και της επέμβασης της Ένωσης στην οικονομική διαχείριση της χώρας, με βασικά σημεία τη θέση της χώρας σε «επιτήρηση» το καλοκαίρι του 2004 και την άνοιξη του 2009, και αποκορύφωμα τη σύναψη του «Μνημονίου» μετά την κρίση χρέους που ξέσπασε στη χώρα. Επισημαίνεται ότι η περιπέτεια της Ελλάδας, και κυρίως η ανάγκη προστασίας του Ευρώ, είχαν ως συνέπεια την επιδίωξη να προβλεφθεί και να προσδιοριστεί η δυνατότητα χορήγησης χρηματοδοτικής ενίσχυσης της Ένωσης σε κράτος μέλος που αντιμετωπίζει δυσκολίες. Αναλύονται οι δύο νέοι θεσμοί που γεννήθηκαν από την ελληνική κρίση, ήτοι ο Κανονισμός (ΕΕ) αριθ. 407/2010 για τη θέσπιση του ευρωπαϊκού μηχανισμού χρηματοοικονομικής σταθεροποίησης και το Ευρωπαϊκό Ταμείο Χρηματοπιστωτικής Σταθερότητας. Τέλος επισημαίνεται η ανάγκη για καλύτερο συντονισμό της πολυμερούς εποπτείας και εμβάθυνση του προληπτικού θεσμικού πλαισίου της Ένωσης, με παράλληλο σεβασμό των ιδιαίτερων χαρακτηριστικών της οικονομίας κάθε κράτους μέλους, όπως και η ανάγκη δημιουργίας ευρωπαϊκών θεσμών ικανών να αποτελέσουν ανάχωμα στις ορέξεις των αγορών. Αντίστοιχα, σε εθνικό επίπεδο, σημειώνεται η αποδόμηση του κράτους και της οικονομίας του και η ανάγκη αναδιάρθρωσής του, μέσα όμως από το σεβασμό των ανθρωπίνων δικαιωμάτων και του κοινωνικού κράτους

Troponin elevation in subarachnoid hemorrhage

Troponin (tr) elevation in aneurysmal subarachnoid hemorrhage (SAH) patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words: “troponin elevation” and “subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG) changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr >1 μg/L), worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients' cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians

Can a pneumothorax break your heart?

Takotsubo cardiomyopathy or apical ballooning is a condition characterized by transitory left ventricular dysfunction, affecting commonly postmenopausal females after foregoing acute emotional or physical stress. We report a case of a 63 year old female presenting with severe dyspnea and right-sided secondary spontaneous pneumothorax, initially treated with tube thoracostomy. Despite the fact that pneumothorax resolved, shortness of breath persisted and due to ST-segment elevation and increased Troponin I levels, she was admitted to cardiac catheterization. A significant coronary stenosis was ruled out and the diagnosis of a Takotsubo cardiomyopathy was established. Electrocardiographic findings were normalized within three days and attributable to prolonged air leakage. A thoracoscopic apex resection followed by a partial parietal pleurectomy was performed. Although Takotsubo cardiomyopathy is a rare syndrome, it should always be considered as a potential cardiac complication of a pneumothorax.</p

May EPH/Ephrin Targeting Revolutionize Lung Cancer Treatment?

Lung cancer (LC) is the leading cause of cancer death in the United States. Erythropoietin-producing hepatocellular receptors (EPHs) comprise the largest receptor tyrosine kinases (RTKs) family in mammals. EPHs along with their ligands, EPH-family receptor-interacting proteins (ephrins), have been found to be either up- or downregulated in LC cells, hence exhibiting a defining role in LC carcinogenesis and tumor progression. In their capacity as membrane-bound molecules, EPHs/ephrins may represent feasible targets in the context of precision cancer treatment. In order to investigate available therapeutics targeting the EPH/ephrin system in LC, a literature review was conducted, using the MEDLINE, LIVIVO, and Google Scholar databases. EPHA2 is the most well-studied EPH/ephrin target in LC treatment. The targeting of EPHA2, EPHA3, EPHA5, EPHA7, EPHB4, EPHB6, ephrin-A1, ephrin-A2, ephrin-B2, and ephrin-B3 in LC cells or xenograft models not only directly correlates with a profound LC suppression but also enriches the effects of well-established therapeutic regimens. However, the sole clinical trial incorporating a NSCLC patient could not describe objective anti-cancer effects after anti-EPHA2 antibody administration. Collectively, EPHs/ephrins seem to represent promising treatment targets in LC. However, large clinical trials still need to be performed, with a view to examining the effects of EPH/ephrin targeting in the clinical setting

Evaluation of Image Quality of Overweight and Obese Patients in CT Using High Data Rate Detectors

Background/Aim: To evaluate the impact of high data rate and sampling frequency detector technology compared to standard scan equipment on the image quality in abdominal computed tomography (CT) of overweight and obese patients. Patients and Methods: A total of 173 patients were retrospectively included in this study. Objective image quality in abdominal CT was evaluated using comparative analysis with new detector technology prior to market launch and standard CT equipment. Contrast noise ratio (CNR), image noise, volumetric computed tomography dose index (CTDIVol), and figures of merit (Q and Q1) were assessed for all patients. Results: Image quality was superior in the new detector technology for all parameters evaluated. The dose dependent parameters Q and Q1 showed a significant difference (p<0.001). Conclusion: A significant increase in objective image quality could be demonstrated using a new generation detector setup with increased frequency transfer in abdominal CT of overweight patients.ISSN:0258-851XISSN:1791-754